Personality traits of in-patients with substance use disorders in a mental health facility in Nigeria

Substance abuse is a multi-etiological, multi-dimensional and a worldwide problem with an alarming increase in its incidences. This study aimed to evaluate the patterns of use of psychoactive substances and to assess the predominant personality traits among the participants. This cross-sectional study used a purposive sampling technique to examined in-patients with substance abuse problem in a psychiatric facility in Maiduguri. One hundred and four (98.1%) males and (1.9%) females with mean age (x) of 31.1 years and SD (± 7.5) participated in the study. The study revealed cigarette (stimulant) as the most current substance of abuse 74.0%, cannabis (hallucinogen) 71.1%, opiates 69.2% and depressants 60.5%. Additionally, 87.5% of the participants used multiple psychoactive substances. Lastly, 90.4% of the participants’ scores were above the mean on Neuroticism, 73.1% on Psychoticism and 55.8% on Extraversion measures. High scores on the three dimensions of personality traits (Psychoticism, Extraversion and Neuroticism) have significant associations to psychoactive substance abuse. The study, therefore, recommend the incorporation of personality assessment in the routine work up and management of patients with substance abuse problems.


INTRODUCTION
The cost in lives, money and emotional turmoil has made the issues of drug abuse a major concern worldwide (Riding, 1992).Currently, over 8% of the general populations are believed to be users of illegal drugs (Substance Abuse and Mental Health Services Administration, 2003).Opiates continue to be the main drug of abuse in most European and Asian countries and account for 62% of all treatment demands (Word Health Organization, 2004).
In African countries, there is an increasing trend in psychoactive substance use and abuse (Adelekan et al., 2000;Reddy et al., 2007).In South Africa, 28.9% of Cape Town adolescents and 31.8% of Durban adolescents who were presented at trauma units were found to have *Corresponding author.E-mail: victorchid01@yahoo.com.
Author(s) agree that this article remain permanently open access under the terms of the Creative Commons Attribution License 4.0 International License positive breath for alcohol, also 15.4% of Cape Town adolescents and 28.6% of Durban adolescents tested positive for methaqualone (Parry et al., 2004).Another study in Africa shows that the bulk of all treatment demand was linked to cannabis use 64% (WHO, 2004).In Nigeria, substantial percentage of national budgetary health allocation is utilized for treatment and rehabilitation of people with substance use problems (Adelekan, 1996).Based on this, the Nigerian government has declared various "war on drugs" but the problem remains.
The sociodemographic profiles of substance abusers in a south-western Nigerian Psychiatric facility, as documented by Abayomi et al. (2012) revealed that males constituted the significant majority (85.7%), and their mean age was 31.8 years.Most of the respondents were never married (70.5%), about half of them were unemployed and 61.9% of them had less than secondary education.Another research in the southern part of the country by Eze et al. (2009) looked at the psychosocial characteristics of patients admitted to a drug rehabilitation unit found similar outcomes.In addition, most of the respondents used different combinations of psychoactive substances.
Studies have reported that psychoactive substance use is prevalent in Nigeria.Alcohol was reported to be the commonly use drug, both in terms of lifetime and recent use history, then tobacco, sedatives, stimulants and cannabis respectively meanwhile cocaine or other drugs was very rare (Gureje et al., 2007).Similarly, in another study conducted in south western Nigeria among tanker drivers, daily current use pattern for tobacco was the highest 45.5%, alcohol 43.3%, cannabis 16.5%, and caffeine 10.2% (Makanjuola et al., 2014).
Furthermore, in a study by Makanjuola et al. (2007) current use of one or more psychoactive substance was reported by 40.4% of all respondents, 35.6% of whom were using more than one substance.The most frequently used substances (both currently and lifetime) were mild stimulants (33.3%), followed by alcohol (13.6%), sedatives (7.3%) and tobacco (3.2%).No subject reported current use of cocaine or heroin.
Drugs and substances abuse is a significant issue that is hazardous to the health and development of young people and it cuts across age, religious affiliation, ethnicities and social class.Despite continuous enlightenment on the hazardous effects of psychoactive substances by government, non-governmental organization (NGO's) and Health Care Providers (HCP), the demand and quest for it is increasing at an alarming rate.Haladu (2003) gives the following as the main causes of drug abuse; experimental curiosity, peer group influence, lack of parental supervision, personality problems, the need for energy to work for long hours, availability of the drugs and the need to prevent the occurrence of withdrawal symptoms.In another study, peer influence and self induced experimentation were found to be a predisposing factor to substance use and abuse (Makanjuola et al., 2014).Also, a study in India found Peer influence to be responsible for drug use, followed by curiosity (Sharma et al., 2012).
The relationship between personality and drug use is highly complex because the range of personality dimension which have been postulated to exist and which have been hypothesized to influence drug use is extremely broad and the personality factors may influence the use of drug at several levels (Cox, 1985).Lots of studies in different setting among different samples have showed the link between personality characteristics and drug use (Booth-Kewley and Vickers, 1994;Lawal and Ogunsakin, 2012).
Considering the role personality traits play in the aetiology and sustenance of substance use habits, Dubey et al. (2010) demonstrated that substance abusers had a significant high score on the neuroticism and extraversion dimensions when compared to nonsubstance abusers.They further reported that substance abusers were more anxious, hostile, vulnerable to stress and had depressive traits.They were also more excitement seeking and assertive compared to normal subjects.Similar findings were reported among substance abusers by Kannappan and Cherian (1989).
In the Nigerian context, Oluwatelure (1995) found a positive correlation between extraversion and substance abuse.In another study, heavy users had higher scores on measures of psychoticism and neuroticism (Sher et al., 2000).Despite the fact extraversion/introversion traits had been found to be somewhat discrepant among drug abusers, more introversion and low extraversion were found among heavy users (Ebie and Pela, 1981;Rankin et al., 1982).
Several studies have revealed that substance abuse is prevalent among patients in Nigerian psychiatric facilities and particularly, drug treatment units (Adamson and Akindele, 1994;Adamson et al., 2010).Few studies were conducted that assessed the patterns of use among individuals with this problem and to the best of this study knowledge fewer studies assessed concomitant personality traits as vulnerability factor for substance use and mitigating factor for treatment in the Nigerian context.This is the first study in northeastern Nigeria that attempts to address these topical issues.The aims of this study were in two-fold; to evaluate the patterns of use of psychoactive substances among inpatients of the detoxification and rehabilitation wards of the Federal Neuropsychiatric Hospital, Maiduguri and to assess the predominant personality traits among the participants.

METHODOLOGY Research design and setting
This is a cross-sectional survey of individuals with substance use problems using a purposive sampling procedure in the detoxification and rehabilitation units of the Federal Neuropsychiatric Hospital, Maiduguri.This is tertiary psychiatric facility that serves as centre of referral for Neuropsychiatry for the northeast geopolitical zone of Nigeria.

Participants and procedure
A total of 104 in-patients with substance use disorders undergoing detoxification or rehabilitation programmes in the facility were recruited into the study over a period of three years (February, 2011to April, 2014).Inclusion criteria; the participants: must be psychological stable as determined by the management team and must give his/her informed consent to participate.The exclusion criteria were: presence of comorbid psychiatric disorder and presence of florid drug-related symptomatology like withdrawal symptoms.In order to rule out comorbid psychiatric conditions and drug-related withdrawal syndromes among the participants, thorough mental state assessment and physical evaluation were independently conducted by two psychiatrists in the management team.

Data collection
The following instruments were used for data collection: 1.An anonymous sociodemographic questionnaire designed by the authors that sought for variables like age, gender, marital status, religion, educational status, ethnicity, past and current use substance of abuse and route of administration.2. Eysenck personality questionnaire (EPQ-90): This is a 90 item version of the Eysenck Personality Questionnaire (EPQ) that assesses personality traits in adults (>17 years of age).The responses are organized in a dichotomous fashion of "yes" or "no".This instrument was developed by Eysenck and Eysenck (1975) and was standardized for Nigerian use by Eysenck et al. (1977).The instrument assesses three domains of personality; Psychoticism measures extent of an individual's tough mindedness, Extraversion measures the extent of an individual's social interaction with other people, Neuroticism measures the extent of an individual's emotionality and the Lie is a measure of the extent to which a client has responded truthfully to the test items.Eysenck et al. (1977) provided the original norms for Nigerian samples, males 4.62; females 2.97 on 25 items Neuroticism measure, males 13.32; females 14.43 on 21 items Extraverted measure, males 6.43; females 8.42 on 23 items Neuroticism measure and lastly on the Lie scale, males 14.56 and females 13.46.Idemudia (1997) obtained a split-half reliability of 0.80, 0.79, 0.81 and 0.30 for each of the scales P, E, N and L, respectively.The internal consistency was high (alpha coefficient of 0.90 (P), 0.91 (E), 0.89 (N) and 0.40 (L).This present study established Cronbach alpha coefficient of .845; the scale has both content and faces validity.

Ethical consideration
Ethical clearance for this study was obtained from the institutional review board of the Federal Neuropsychiatric Hospital, Maiduguri and was found to be in conformity with the recommendations of the Helsinki declaration for research on human subjects.In addition, informed consents were obtained from the participants.The privacy and confidentiality were guaranteed and codes were used for data entry in order to maintain anonymity.

Data analysis
The data obtained were analyzed using the Statistical Package for Social Sciences, version 16.Descriptive statistics were used to Onyencho et al. 3 analyze the demographic characteristics of the participants and their patterns of substance use.Furthermore, descriptive statistics were also used to summarize the total numbers of participants that fell under the categories of each personality traits taking into consideration the mean value for each of the trait as standardized for Nigerian sample (Eysenck et al., 1977).

RESULTS
Table 1 shows the summary of socio-demographic characteristics of the participants.The age ranges from 17 to 57 years with mean age of 31.1 and (SD ± 7.5).There were more males than female.Majority were single, religious affiliation shows more Moslems than Christians; employment rate was relatively high as most of the participants were employed in public and private sectors while others were either students, peasant farmers, artisans and petty traders, majority had at least secondary school education.Table 2 revealed various reasons given by the participants for engages in substance abuse, more participants engage in substance as a result of the peer influence, followed by experimentation/curiosity. Others reason given were to increase performance and due to medical conditions (sickle cell anemia).Table 3 shows the current and past use of substance abuse.The most current substance of abuse are as follows; cigarette, cannabis, tramadol, alcohol, rohypnol, diazepam, codeine, other substance of abuse, "sukudye", pentazocine, heroin, solution respectively.Furthermore, the most significant past substance of abuse are as follows; tramadol, cannabis, diazepam, cigarette, rohypnol, alcohol, codeine, other substance of abuse, "sukudye", pentazocine, respectively.
Table 4 shows current patterns of psychoactive substance of abuse according to its effect on the central nervous system (CNS).A high numbers of the participants uses stimulants (cigarette) and hallucinogen (cannabis), followed by opiates, then depressants.A small percentage of the participants use either of the substances under volatile solvents, while another fraction uses other drugs of abuse.Table 5 shows that majority of the participants used multiple psychoactive substances while a small number of the participants only used one psychoactive substance.
Table 6 shows the percentage of participant's personality traits on Eysenck Personality three dimensions.73.1% of the participants scored above the mean while 26.9 scored below the mean on the Psychoticism measure, 55.8% scored above the mean while 44.2% scored below the mean on the Extraversion measure.Lastly, 90.4% scored above the mean while 9.6% scored below the mean on Neuroticism measure.In other to ascertain how truthful the participants has responded to the items of the test, the Lie scale was also computed, 74% of the participants score below the mean which is an indication of a valid response while 26% score above the mean which is an indication of faking or random responses.

DISCUSSION
Socio-demographical characteristics of the participants in this study revealed that most of participants were in their early adulthood, majority were males and single.
Employment rate was relatively high as most of the participants were employed in public and private sectors while other were either students, peasant farmers, artisans and petty traders, majority had at least secondary school education.This finding is also supported by Abayomi et al. (2012) who found a mean age of 31.8 in their study and reported that most of their participants were males, and never married.Similarly, Eze et al. (2009) reported most of their respondents to be male, single and unemployed.However, the discrepancies here is between educational attainments and employment status of the participants in this present study, 50% attended secondary school education and 40.4% attended tertiary education making a total of 90.4% while Abayomi et al. (2012) reported that 61.9% had less than secondary school education in their Note: Current use of substance is the usage within the last three month as categorized by World Health Organization (WHO) using ASSIST Questionnaire.Other substance of abuse includes passion energy drink and benzhexol (anticholinergic effect).
study, also, Eze et al. (2009) reported high level of unemployment in their study.Sampling bias and operation classification of employment status may explain the discrepancies observed in the present study.Modes of initiation into psychoactive substance were widely reported in the literatures, peer influence, followed by curiosity and to increase performance/activities were found in this study as contributors.This findings was in line with the previous studies that reported peer influence and self induced experimentation/curiosity as some of the risk factors to substance use and abuse (Makanjuola et al., 2014;Sharma et al., 2002;Haladu, 2003).
Patterns of use and current psychoactive substance use were looked into.Cigarette and cannabis were found to be the most currently used substances, followed by tramadol.This finding was in agreement with Makanjuola et al. (2014) finding that tobacco is the most currently use substance, followed by alcohol, caffeine, and cannabis.In another study with similar finding, cannabis was found to be prevalent and linked to the bulk of the treatment demand (WHO, 2004).However, this seems to differ from the study of Gureje et al. (2007) which reported alcohol to be the most commonly use drug in Nigeria, followed by tobacco, sedatives, stimulant and cannabis.The controversy here is the first ranking of alcohol; in this present study tobacco (cigarette) was found to be the most current used drug, followed by hallucinogen (cannabis) in this part of the country.The Islamic injunction against the use of alcohol seems to be a factor here since 80% of the participants of this study were Moslems.Moreover some of the earlier mentioned studies were conducted in other part of the country where majority of their participants were Christians.
Similarly, current patterns of use by classifying the substances into some groups according to its effect on the CNS.Majority of the participants used stimulants, followed by hallucinogen, then opiates.This finding is also consistent with the results of previous studies of Makanjuola et al. (2007Makanjuola et al. ( , 2014) ) that ranked stimulant as the most frequently used substances.
Furthermore, multiple psychoactive substance use is another phenomenon to be focus on in a study on substance use in our society because of the different chemical interaction involved.Majority of the participants in this study were currently using two or more psychoactive substances.This is contrary to the finding

Table 1 .
Socio-demographic characteristics of the study participants.

Table 2 .
Mode of initiation of the participants into psychoactive substance use.

Table 3 .
Current and past use of psychoactive substance.